PONE-D-24-27432Using the Behaviour Change Wheel to develop an intervention to improve conversations about recovery on the stroke unitPLOS ONE

Dear Dr. Burton,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Dec 02 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Lesley Smith, PhD

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating the following financial disclosure: Funding for this work was provided by the Stroke Association, via its Postgraduate Fellowship programme [ref: TSA PGF 2017-02].   

Please state what role the funders took in the study.  If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" 

If this statement is not correct you must amend it as needed. 

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. 

Before we proceed with your manuscript, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible.

Please update your Data Availability statement in the submission form accordingly.

4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

5. Your abstract cannot contain citations. Please only include citations in the body text of the manuscript, and ensure that they remain in ascending numerical order on first mention.

6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

Additional Editor Comments:

The manuscript reports on an important topic using gold-standard methodological frameworks. It is well written on the whole and easy to follow, however there are areas where more or clearer information is required. These are outlined below:

Overall, throughout the manuscript, the relationship between BCW, COM-B and TDF and how they were applied is not clear. A diagram illustrating this relationship might help show this more clearly. Presumably it was an iterative process?

Abstract conclusion needs revising. It should more accurately reflect your findings rather than stating what you did. Perhaps phrasing it along the lines of "the application of the COM-B (or is it BCW?) to intervention development for......was successful......further research will......

The conclusion should match the conclusion in the main body of the manuscript.

Background

The aim of the work needs stating. You may also consider stating some objectives which could link to the different phases of the research. This would help structure the methods and results.

Methods

There is a lack of consistency in your use of COM-B and BCW. COM-B model applied in first paragraph, but then in phase 1 it is BCW. Also in your use of terms such as multi-phase, then you mention phase 1. Be very clear how many phases there were in the first paragraph and briefly describe them before going into the details in subsequent paragraphs.

There is scant information on how the TDF was applied - please expand on this. Why was it used?

More detail is required on how APEASE was judged or applied?

The rationale for only shortlisting 5/6 barriers is required.

Results

How were the barriers mapped to the TDF domains?

47 stakeholders in the text but 48 in the table.

You selected 6 barriers but the results indicated that all were very or extremely important to address. This needs further explanation and the implications of this need picking up in the discussion.

Table 4 describes intervention components but how these were specified and selected needs explanation.

Discussion

The initial paragraph should answer the extent to which you addressed your aim rather than re-stating your aim. The first sentence could be broken into 2 to make a clearer message.

Please clarify if the selection of barriers was informed by the survey rather than previous work. Previous work identified them but you selected the ones to address in the survey?

The discussion would benefit from re-structuring so that you clearly describe what you found first before you make comparisons with the wider literature.

Line 395 - rather than describing the MRC framework and BCW again discuss how these facilitated your research aims and objectives. Discuss the application of it rather than rationale for it's use.

Expand on your statement that the final intervention will be flexible - what does this mean and how will it be adaptable to other settings, populations etc.

line 380-382 - this belongs in the introduction/background section as it provides a rationale for your study.

Conclusion

This should align with the abstract conclusion and needs improving. You used frameworks and processes for intervention development. To what extent did these enable you to achieve your aims, any limitations and what comes next.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting manuscript and although I am from a different discipline, it was exciting to consider how this approach could be applied across different areas of healthcare.

Please find below a couple of minor comments to consider which could be clarified further to enhance the readability / improve the accessibility and add to the interest of the paper. Some readers may be reading your paper for your methodological approach rather than topic itself, so it is good to consider this too.

Maybe consider providing a little more detail about the TDF. This would help to show the reader why you used both the TDF and COM-B, rather than one or the other.

Overall, I felt that you have explained quiet a complicated methodology well and the tables do help to clarify the different aspects and show your rational and explanations for each. It did take some time to understand and follow all of the stages, so if there was a way to reduce / make any sections more concise, this would help the overall readability, but I understand that this may not be possible to do without losing the required level of detail.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Using the Behaviour Change Wheel to develop an intervention to improve conversations about recovery on the stroke unit

PONE-D-24-27432R1

Dear Dr. Burton,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Lesley Smith, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

You have revised the manuscript by addressing the peer review comments and have managed to describe your methodological processes clearly and comprehensively. I think the amendments have improved the manuscript, and it is ready to be published. Well done.

Reviewers' comments: